Provider Demographics
NPI:1154144939
Name:ESTRADA, STALINA MAUREEN
Entity type:Individual
Prefix:
First Name:STALINA
Middle Name:MAUREEN
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11845 SYCAMORE LN
Mailing Address - Street 2:
Mailing Address - City:ELBERTA
Mailing Address - State:AL
Mailing Address - Zip Code:36530-2783
Mailing Address - Country:US
Mailing Address - Phone:251-419-3120
Mailing Address - Fax:
Practice Address - Street 1:11845 SYCAMORE LN
Practice Address - Street 2:
Practice Address - City:ELBERTA
Practice Address - State:AL
Practice Address - Zip Code:36530-2783
Practice Address - Country:US
Practice Address - Phone:251-419-3120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician